CORONARY HEART DISEASE
Risk Factors for Coronary Heart Disease
Coronary heart disease appears in two main forms, angina
and heart attack, and is the major cause of death in most
developed countries. Its development is influenced by a
number of risk factors.
Coronary heart disease (CHD) is more likely 1)with increasing
age, 2) in men rather than in women before the menopause
3) if close relatives have suffered CHD early in life. These
risk factors cannot be changed. But there are other risk
factors that can be modified.
The main modifiable risk factors for CHD are:
- Elevated blood cholesterol
- High triglyceride with low HDL
- Elevated blood pressure
- Diabetes
- Smoking
- Obesity
- Inactivity
- Excessive alcohol
- Excessive stress
When several such risk factors exist together, the risk
of CHD is much increased. It is not enough to consider just
one risk factor. All aspects of diet and lifestyle should
be kept under review.
Blood Cholesterol
Cholesterol is vital for healthy cells. It is so important
that the body does not rely on a dietary source, it makes
its own. If, however, the body accumulates too much, cholesterol
will deposit in the walls of arteries, which become damaged
and may become blocked. If this happens, a heart attack
could result. Many people make too much cholesterol when
their diet is rich in saturated fats.
High blood cholesterol may also be inherited, as in Familial
Hypercholesterolaemia (FH) and Familial Combined Hyperlipidaemia
(FCH). In these conditions there are genetic defects that
lead to over-production or accumulation of cholesterol in
the blood. To combat this, a rigorous cholesterol-lowering
food plan, usually combined with drug treatment, is required
to reduce and control blood cholesterol and CHD risk.
Even if one’s blood cholesterol is not exceptionally
high, as it is in the inherited disorders FH and FCH, it
is sensible to choose carefully the amount and type of dietary
fat consumed. Reducing the amount of saturated fat is especially
important. (The FHA has a separate publication on healthy
eating *).
High Triglyceride with Low HDL
Having too much of another fat in the blood, triglyceride,
is often coupled with having too little HDL (high density
lipoprotein). This combination is commonly associated with
premature coronary disease. It may be inherited but also
occurs in individuals who are obese. Weight reduction and
regular exercise may help to reduce triglyceride levels
and increase HDL levels.
A higher level of HDL is useful, as this is the component
in the blood which brings excess cholesterol from the tissues
to the liver for processing and excretion. Insufficient
HDL in the blood appears to be an important predictor for
heart disease in European and North American men and women.
Blood Pressure
High blood pressure is harmful to the arteries and increases
the risk of heart attack, heart failure and stroke. The
condition tends to run in families, but blood pressure is
also influenced by lifestyle. To prevent blood pressure
from rising, people are encouraged to achieve and maintain
a healthy body weight, keep alcohol intake moderate, avoid
adding or cooking with salt, reduce stress, and be physically
active. If these measures fail, there are drugs which are
effective in reducing elevated blood pressure. Excess alcohol
intake seems to be an important contributor to high blood
pressure in Britain.
Diabetes
Having diabetes increases the risk of CHD. Known diabetics
are under the care of a doctor and dietitian. But it is
possible to have a mild diabetic condition or latent diabetic
tendency without knowing it, which also increases CHD risk.
Diabetes and diabetic tendencies can be managed by a diet
which emphasises complex carbohydrates and is low in fat.
Good choices are foods rich in starch and fibre, such as
potatoes, bread and other cereal foods, pasta, beans, vegetables
and fruit. Be active, maintain a healthy body weight, and
above all - do not smoke.
Smoking
Cigarette smoking, even a few a day, increases the risk
of heart disease. It can also cause cancer of the lungs
and several other parts of the body, lung failure, stroke
and gangrene. There are thus many health benefits from being
a non-smoker. Even after having smoked for many years, stopping
smoking now will reduce CHD risk.
Obesity
Being overweight increases the chance of having a heart
attack. This is in part because obese individuals are more
likely to have high blood pressure, diabetes and high blood
fats. Less fat, sugar and alcohol in the diet is helpful
for weight control. In order to achieve a healthy body weight
it is also important to build regular, moderate exercise
into a daily routine.
Inactivity
Physical inactivity is an important contributor to coronary
heart disease. Cardiovascular benefits of regular physical
activity include reduced blood pressure and less likelihood
of obesity, which help to reduce the risk of developing
CHD. At least 30 minutes of steady activity five days a
week, or 20 minutes of higher intensity activity three days
a week is recommended. Walking, swimming, cycling and dancing
are all excellent choices. Those who have CHD or feel they
are at risk should consult their doctor before starting
an exercise programme.
Alcohol
Alcohol in moderation may reduce the risk of CHD. However,
consuming too much alcohol places one’s health at
risk in a number of ways. When taken to excess, alcohol
is detrimental to the heart and other organs. It can directly
damage the heart muscle and cause irregular beating of the
heart. Alcohol can contribute to obesity, high triglycerides,
high blood pressure, strokes and cancer, not to mention
accidents and violence.
There are many reasons to keep alcohol consumption within
reasonable limits. Men are encouraged to drink no more than
28 units a week and women no more than 21 units. A unit
is defined as a half-pint of beer, lager or cider, or a
pub measure of wine, sherry or spirits.
Stress
A certain amount of stress may be desirable, in that it
keeps people alert and motivated. However as the stress
level builds, and especially if prolonged, it can be counter-productive
by being injurious to health. Stress can exacerbate symptoms
in people with pre-existing heart disease, and can contribute
to high blood pressure. For those with high cholesterol
it can lead to neglect of a healthy lifestyle, such as poor
eating habits, or not taking prescribed medication.
It is important to find time for relaxation. Simple breathing
exercises, sports, music, meditation, reading, engaging
in hobbies, taking a walk...there are many ways to reduce
stress. Choose those which appeal and make time for them
every day.
Information Courtesy of
The Family Heart Association, 7 North Road, Maidenhead,
Berkshire, SL6 1PE, UK.
Charity registration No: 1003904. Company limited by guarantee
No. 2631049.
Telephone: 01628 628 638. Email: md@familyheart.org
© 1999 The Family Heart Association
For Further information or for fact sheets on the
following:
- Risk Factors for Coronary Heart Disease
- Cholesterol and Lipoproteins
- Triglycerides
- Fibrates
- Resins
- Statins
- Exercise: An Investment in Health
- Stress
Visit the website: www.familyheart.org
